Monday, October 25, 2010

Going Beyond the Scope of Practice – The Follow Up

I haven’t been doing so well since last week. I’ve been worried about how I would deal with that doc when I’d see him, how my manager would react, how far up the food chain this incident would have to travel and how exactly I would compose my words so I wouldn’t sound like a bumbling idiot. I’m not very articulate when stressed. I was scheduled to work four nights, two of which had to be with that doctor. He completely ignored me for both of the nights which as we all know is highly conducive to patient care (note sarcasm). I approached him on the second night to offer an olive branch but my efforts were in vain. “Next time I talk to you, it will be with our bosses” were the only words he said to me in two nights. Not kicking him was an overwhelming exercise in self-control. I’m still waiting for an official meeting with my manager but she sent me an email saying that she’s reviewing the chart along with the doctor’s manager and so far my documentation is air tight. Some of my MD buddies have also sent me very supportive emails. This is a relief but I’m still waiting to see what happens next.

Now that I’ve had some time to process the incident, I’m really pissed. I have a feeling that I’m going to have to do BS workshop about scope of practice, regulatory standards and how to properly escalate issues up the all knowing hierarchy. I already know all that. I don’t want to imagine what would have happened if I was wrong. What I want to know is if the doc will get a slap on the wrist or actually be made to examine his own issues that nearly led to a volvulus being missed if an x-ray wasn’t ordered by a nurse who hasn’t been alive as long as he’s been practicing medicine. I hate being a team player with a person who thinks his word is law and is in dire need of accepting a retirement package.

I'm so sorry you were treated so badly! I'm a student, and I had a placement in A&E and NEVER EVER would a doc ignored a nurse's concerns about a pt like that, even a regular attender! It's COMPLETELY inappropriate AND unethical. He doesn't deserve to work with nurses like you! Stick to what you did, you absolutely did the right thing. You really did try your hardest to go through the right channels, and you understand that what you did was technically not okay, but what they have to understand is that you didn't want to - the doc forced you into it by not listening to your concerns! That patient could well have DIED if you hadn't done what you did. You did the right thing and you can't make anyone make you think you didn't. Yes, it's important to have structure and hierarchy etc etc, but it's also important that doctors listen to the concerns of educated, intelligent and experienced nurses! I hope everything works out.

agree with omdg. the md ultimately calls the shots, takes the responsibility, and the lion's share of the reward. but there is no omniscience, and the input of the wisdom, experience, and observations of all involved should be actively cultivated in decision making. including asking the patient. carry on, girl.

I'm sure you'll do fine. Unless the entire administration are a bunch of blithering idiots, it'll be obvious to everyone that you were right, went above and beyond to get the doctor to actually do his job and care for the patient, and he still acted like an ignorant ass. Just be confident that you're in the right.

I can't help thinking this whole situation is very sticky. I truly hope that you at most get a slap on the wrist and that the doc gets his ass handed to him. Anyway, I'm sending you a lot love from this tired and overworked danish nurse.

I'm sorry this has gone so far and I really hope this can be resolved satisfactorily. I am also really, really concerned about the practice issues and the fact this has been bumped up to your manager. Can you email me at torontoemergencyrn(at)gmail(dot)com. I'm worried for you.

I hope to GOD that your manager backs you up, if not she's not worth working for.

If you can't trust your manager to stand behind you when you do something *right* then what can you expect if you ever make a mistake???!?!

You will probably have to do all the things you are anticipating (which is STUPID) when really should be getting a bouquet of flowers from the lawyer on retainer for the hospital---but that would be in a world where using your brain and saving a life are rewarded instead of punished.

I suppose that you will have to take comfort in the fact that no matter how much shit you get in, you saved a person's life because of your instinct and assessment skills. That knowledge may seem like cold comfort but really, it is the greatest thing you could do for a patient/another human being.

You did what was right no matter what the protocols and pencil pushers say.

Hmm. Some of the commenters here seem to be getting kind of kerfluffled & overly worried. All you did was order an x-ray. Yes, it's beyond the scope of practice. But, it was based on a thorough, experienced and intelligent assessment, and it's not like you didn't try to get the order from a doc first (2 docs, actually). I'm betting that if you'd discharged her per the MD's orders you'd likely be in a lot more trouble, not to mention considerably greater moral distress.In school we were taught that the nurse is the last line of defense for the patient, this whole incident clearly demonstrates that.

the MD probably was not used to having it pointed out to him (except as a resident) that he was wrong, and coming from a "lowly" nurse (in his mind only) took it as a social slight.... he is embarassed/angry...probably had flashbacks to some horrible treatment by some attending after making mistakes when he was a medical student/resident. Not a defense, just an explanation. Of course, it may be that he thinks so highly of himself that he couldn't possibly make an error. Hopefully management can see through it - because any MD that is good will graciously admit to a mistake and move on. Your manager should support you in this if they are any good at all.

I feel it is not a good idea to get into a pissing contest.In Life my friend..we must pick our battles.We each do what we feel is best..you did this.Now if you must explain either in writing or in a meeting,consider Listening more than you talk.Answer questions with as few words as possible.I have found it to be true in Life, things have a way of working out.May you choose to be respectful to this person and discuss it no further with those who were not there.Yes my friend many of us have been where you are and have survived.So move past this and Live Love and Laugh as much as possible and do not spend one more minute of your time and energy on the past.

Even if you do get scolded, the doc will get it worse. Unfortunately, it probably will not happen in front of you and he won't be required to apologize to you. Live in the secret knowledge that he is getting his ass handed to him by his superiors.

About Me

Obvious Disclaimer

I like my job. I do not want to lose it for violating patient confidentiality. I have a fairly active imagination so altering identifying details is something I enjoy. Everything here is altered to protect patient confidentiality. If you think that a story is referring to you, it’s not. If you think a picture is from your medical exam, it’s not.